14 Jun CTO Cartu Jon Reports – She Survived the Coronavirus. Then She Got a $400,000 Medical Bil…
Janet Mendez started receiving bills soon after returning in April to her mother’s home from Mount Sinai Morningside hospital, where she nearly died of Covid-19. First, there was one for $31,165. Unable to work and finding it difficult to walk, Ms. Mendez decided to put the bill out of her mind and focus on her recovery.
The next one was impossible to ignore: an invoice for $401,885.57, although it noted that the hospital would reduce the bill by $326,851.63 as a “financial assistance benefit.” But that still left a tab of more than $75,000.
“Oh my God, how am I going to pay all this money?” Ms. Mendez, 33, recalled thinking. The answer came to her in about a second: “I’m not going to be able to pay all this.”
Ms. Mendez is optimistic that her insurance company will cover a large part of the costs, but only after receiving a series of harassing phone calls from the hospital about payment.
A spokesman for the hospital told The Times that Ms. Mendez erroneously received a bill that should have gone directly to her insurance company or the government. Coronavirus patients, through a series of federal aid packages, are supposed to be largely exempt from paying for the bulk of their care.
But mistakes are likely to occur, particularly given the number of people who have recently lost their health insurance amid an economic downturn and widespread job loss. And when they do happen, patients like Ms. Mendez will be the ones to have to sort out the complicated billing process at a time when they are still recovering from Covid-19.
“We’re looking at a tsunami,” said Elisabeth Benjamin, a vice president at the Community Service Society of New York, which is trying to help Ms. Mendez get her bill reduced. “The earthquake has struck, and now we’re waiting for the bills to roll on in.”
When Ms. Mendez got over the initial shock and examined her bill more closely, she was struck by how vague and arbitrary the charges seemed. She was billed $3,550 for “inpatient charges” and another $42,714.52 for “pharmacy,” but without any breakdown of what medicines she received or how much each cost.
Ms. Mendez said the bill should have at least been itemized, listing each drug she was being charged for — and the price. She was, after all, unconscious for much of her hospitalization.
“I don’t know what medicines they put in me,” she said. “I can’t say they did this, or they didn’t do this.”
Most of the line items on her hospital bill are vague. Some of the most expensive are four entries that simply read “Medical — Cardiac Care.” Each one ranges from $41,000 to $82,000.
Part of the confusion was that Ms. Mendez had recently changed health insurers, and she had arrived at the hospital struggling to breathe and without her new insurance information. The hospital billing department concluded she was uninsured and sent her a bill directly.
“To be clear, neither this patient nor any Mount Sinai patient should receive a bill or be expected to directly pay for their Covid-19 care,” a spokesman for Mount Sinai Health System, Jason Kaplan, wrote in an email, describing it as an isolated error.
While eye-popping medical bills are nothing new, Covid-19 patients are supposed to be largely exempt. During Ms. Mendez’s hospitalization, a huge bailout of hospitals was taking shape.
In New York City, hospitals received more than $3 billion in federal payments last month from an early round of bailout payments. The hospital where Ms. Mendez was treated, Mount Sinai Morningside (formerly Mount Sinai St. Luke’s) received at least $63.7 million.
The federal dollars are intended to help compensate hospitals and health care providers for the expense of treating Covid-19 patients like Ms. Mendez. The money is also meant to help make up for the revenue hospitals lost as elective procedures were canceled and non-Covid patients dwindled.
The money comes with some conditions that are intended to protect patients from medical debt. For instance, health care providers are not permitted to seek extra payment from patients with health insurance who received care at an out-of-network hospital. Nor can they “balance-bill” — that is, bill the patient for the difference between what the insurer will pay and the hospital’s charges.
But the protections do not fully insulate patients. Even if a hospital takes federal money, some of the doctors who treat patients there can send their own bills to patients directly.
Ms. Mendez received a bill separate from the hospital. The doctors who cared for her individually charged between $300 and $1,800 for each day. Some days, four different doctors billed her for treatment.
Depending on their insurance plan, patients may still be stuck with paying co-payments, deductibles and a percentage of the bill — which can amount to thousands of dollars, although some plans may limit out-of-pocket costs, said Jack Hoadley, a health policy researcher at Georgetown University.